https://immattersacp.org/weekly/archives/2018/01/30/5.htm

Training in breathing exercises before upper abdominal surgery significantly reduced postoperative pulmonary complications and pneumonia

Study authors noted that the intervention has minimal potential to harm and can be provided within existing hospital clinics that patients must attend before surgery.


Brief training in self-directed breathing exercises before upper abdominal surgery may help patients avoid postoperative pulmonary complications, a recent randomized trial found.

Researchers enrolled adults who were scheduled to receive elective major open upper abdominal surgery (e.g., colectomy, other bowel resection, nephrectomy) at three hospitals in Australia and New Zealand. Overall, 432 patients completed the trial. Within six weeks before surgery, the control group received an information booklet that prescribed postoperative breathing exercises (n=214), while the intervention group received both the booklet and a 30-minute training session with a physiotherapist (n=218), which involved coaching in the breathing exercises, education about pulmonary complications, and an individualized risk assessment.

The primary outcome was incidence of a postoperative pulmonary complication during the patient's hospital stay (up to 14 days). Secondary outcomes included hospital-acquired pneumonia, length of stay, ICU utilization, and hospital costs. Results were published online on Jan. 24 by The BMJ.

The intervention group had a lower incidence of postoperative pulmonary complications than the control group (12% vs. 27%), an absolute risk reduction of 15% (95% CI, 7% to 22%; P<0.001). The incidence remained halved after adjustment for age, respiratory comorbidity, and type of surgical procedure (adjusted hazard ratio, 0.48 [95% CI, 0.30 to 0.75]; P=0.001), and the number needed to treat to prevent one pulmonary complication was 7 (95% CI, 5 to 14). The effect of the intervention was more pronounced in patients having colorectal surgery, in patients younger than age 65 years, in men, and in those who received training from an experienced physiotherapist.

The incidence of hospital-acquired pneumonia was also lower in the intervention group than in the control group (8% vs. 20%; adjusted hazard ratio, 0.45 [95% CI, 0.26 to 0.78]; P=0.005), for a number needed to treat of 9 (95% CI, 6 to 21). There were no significant differences between groups in other secondary outcomes. The study authors noted limitations, such as imbalances in baseline characteristics between groups and limited generalizability.

The intervention has minimal potential to harm and can be provided within existing hospital clinics that patients must attend before surgery, the authors noted. “These results are directly applicable to the tens of millions of patients listed for elective major abdominal surgery worldwide,” they concluded. “This service could be considered for all patients awaiting upper abdominal surgery.”